Gross Observation of Paw Oedema - EVALUATION OF Fructus Viticis METHANOLIC CRUDE EXTRACT AS AN

CHAPTER 4 RESULTS

4.1 Gross Observation of Paw Oedema

Initially all rats showed normal paw appearance with no sign of inflammation such as redness, heat, oedema and pain with average of basal reading of paw thickness 4.9 ± 0.06 mm. At the beginning of vehicle+saline injection, all rats in the group developed minor oedema due to the introduction of needles into the hind paws and resolved to normal size after 24 hours as shown in Figure 4.1 (B). As expected animals injected with DMSO+2% (w/v) λ-carrageenan developed massive oedema with clear cardinal sign of inflammation which are redness, heat, swelling and sign of pain even after 24 hour post injection as shown in Figure 4.1 (C). Despite of that, rats that were treated with Fructus viticis extract (50 mg/mL extract + carrageenan) seems to have delay in the oedema development compared DMSO + carrageenan treated group which developed severe oedema. In addition, animals that received 50 mg/mL extract + carrageenan treatment shows less severe inflammatory sign compared to carrageenan group as shown in Figure 4.1 (E). Meanwhile, LNMMA + carrageenan treated rats also developed massive oedema which is comparable to DMSO + carrageenan group (Figure 4.1 (F).

Figure 4.1 Gross observation of rat hind paws at 24 hours post injection with treatments. (A) Comparison between ipsilateral (injected) and contralateral (non-injected) paws. (B) Ipsilateral paw of vehicle + saline. (C) Ipsilateral paw of DMSO + 2% λ- carrageenan showing intense inflammation manifested by severe oedema. (D) Ipsilateral paw of 50 mg/mL extract + saline. (E) Ipsilateral paw of 50 mg/mL extract + carrageenan showing less inflammation. (F) ipsilateral paw of LNMMA + carrageenan.

Ipsilateral Contralateral

Oedema

A B C

D E F

54 4.2 Paw oedema

In this study, the development of paw oedema after treatment/carrageenan injection was investigated for 24 hours. Results revealed that the measurement of normal paw thickness of all rats before injection of treatment/carrageenan was in average of 4.2-5.4 ± 0.06 mm Generally, most of paws were having swollen paw after 30 minutes of vehicle/treatment+saline/carrageenan injection which due to small injury caused by injection needle and administration of fluid (150 ul). Paws treated with DMSO+saline started to resolved from 1 hour (6.3 ± 0.4 mm) and the paw thickness was maintained until 24 hours (5.5 ± 0.3 mm) with no obvious cardinal signs of inflammation as shown in Figure 4.2. In this study, Fructus viticis crude extract that was used as treatment did not cause any significant inflammation with no significant alteration of paw oedema at all-time point when compared to control (DMSO+vehicle) as shown in Figure 4.2. As expected, injection of 2% λ-carrageenan has produced a massive oedema which manifested by the increasing of paw thickness at all-time points until 24 hours. The paw thickness injected with carrageenan increased almost 50% at 24 hours (8.4 ± 0.2 mm; p<0.0001) when compared to the basal reading (5.0 ± 0.1 mm). Interestingly, in this study, we have demonstrated that rats that received 50mg/ml of Fructus viticis crude extract prior to carrageenan injection has showed a significant (p<0.01) delayed of oedema development in paws when compared to paw of rat injected with DMSO+Carrageenan at 4 hours (Extract+Carr: 8.7 ± 0.2mm vs DMSO+Carr: 9.9 ± 0.2 mm) and 6 hours (Extract+Carr: 8.7 ± 0.3 mm vs DMSO+carr: 9.9 ± 0.2 mm).

However, after 8 hours to 24 hours there is no significant effect of anti-inflammatory activity of the extract when compared to the DMSO+carrageenan group as shown in Figure 4.2 and Figure 4.3.

LNMMA is nitric oxide synthase inhibitor that is expected to reduce the development of inflammatory mediator nitric oxide (NO). However, in this study, we have demonstrated that LNMMA did not cause any significant reduction of paw oedema caused by the carrageenan. There was no significant difference when compared to DMSO + carrageenan group as shown in Figure 4.2 and Figure 4.3.

Basal

Figure 4.2 Comparison of mean paw thickness (mm) of the rats treated with different treatment at different time interval for 24 hours. Paw oedema was measured using digital vernier caliper. Carrageenan injection has results in enormous paw oedema at all-time point when compared to saline group. Extracts exhibits anti-inflammatory effect by delaying the paw oedema and significantly (^aP<0.01) different at 4 hours and 6 hours when compared to DMSO + carrageenan group (n=6).

Figure 4. 3 Representative of paw thickness measurement at 24 hours post treatments injection by using digital vernier caliper; A: DMSO + saline, B: DMSO + carrageenan, C: 50 mg/mL extract + saline, D: 50 mg/mL extract + carrageenan, E:

LNMMA + carrageenan.

A C

57 4.3 Pain behaviour

Apart of evaluating the oedema development, in this study, the effect of carrageenan/treatment to the development of pain (nociception) in the hind paw was also investigated. Generally, the measurement of mechanical nociception threshold for all rats before experimentation was ranged from 107.5-200.0 g (168.8 ± 5.4 g).

At the beginning of vehicle/treatment+saline/carrageenan injection, the rats probably experienced pain from the introduction of the needle thus all rats showed reducing in mechanical nociception threshold. However, mechanical nociception of rats treated with DMSO + saline started to resolved from 1 hour (161.7 ± 13.7 g) and the pain threshold was maintained until 24 hours (154.7 ± 16.0 g). As expected, injection of 2% λ-carrageenan results in decreasing of mechanical nociception threshold at all-time points until 24 hours. Pain threshold of the rats injected with carrageenan decrease almost 50% at 24 hours (81.24 ± 10.4 g) when compared to the basal reading (147.2 ± 13.1 g). Interestingly, in this study, we have demonstrated that rats that received 50mg/ml of Fructus viticis crude extract prior to carrageenan injection has showed a significant (p<0.05 & p<0.01) increased of mechanical nociception threshold (resolution of pain) when compared to rats injected with DMSO+Carrageenan at 1 hour (Extract+Carr: 123.7 ± 9.1 g vs DMSO+Carr: 63.6 ± 8.7 g) to 6 hours (Extract+Carr: 97.0 ± 9.7 g vs DMSO+Carr: 37.6 ± 3.9 g).

However, after 8 hours to 24 hours there was no significant analgesic effect of the extract when compared to the DMSO+carrageenan group as shown in Figure 4.4.

Fructus viticis crude extract that was used as treatment did not cause any significant increase in pain as there is no significant reduction of mechanical nociception threshold at all-time point when compared to control (DMSO+vehicle) as shown in Figure 4.4.

Nitric oxide is one of the inflammatory mediators that will sensitise nociceptor neuron thus will results in pain. Since LNMMA is nitric oxide synthase inhibitor, the rats treated with LMNNA are expected to reduce pain thus increase the pain threshold. However, there is no significant difference of pain threshold of rats in LNMMA + carrageenan group when compared with DMSO + carrageenan group.

Figure 4.4 Comparison of mean mechanical nociception threshold (g) of rats treated with different treatment at different time interval The mechanical nociception threshold were measured using Ugo Basile Analgesy-Meter of Randal-Selitto.

Fructus viticis extracts produces analgesic effect by delaying acute pain at certain time points which are from 1 to 6 hours ^aP<0.01 & ^bP<0.05 when compared with DMSO + carrageenan. .

4.4 Blood pressure

Systolic blood pressure of the rats at different time intervals was ranged between (80-180 mmHg). The result of systolic blood pressure shows that there were no significant different between all groups of the animals at all-time interval (Figure 4.5). These indicate that there were no systemic and centralize pain experienced by the rats. The rats only experienced peripheral and localize acute pain as a result of

2% λ-carrageenan.

Figure 4.5 Comparison of mean systolic blood pressure at different time intervals. Blood pressure of all rats were measured using the Mouse Rat Blood Pressure (MRBP) non-invasive tail cuff method. No significant different in blood pressure measurement in comparison between all treatments thus indicates that the animals did not experienced severe pain at all-time points.

Basal

30 m

in 2 6 12 24

0 20 40 60 80 100 120 140 160 180 200

Post carrageenan injection (hours) Systolic Blood Pressure (mm/Hg)

DMSO+Saline DMSO+Carr

50mg/mL Extract+Saline 50mg/mL Extract+Carr LNMMA+Carr

60 4.5 Full blood count (FBC)

As shown in Figure 4.6, there were no significant different in total red blood cells, hemoglobin, hematocrit-packed cell volume (HPCV), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), red cell distribution width (RDW) and platelet when compared between different groups of treatment.

Figure 4.6 There are no significant different in total RBC, hemoglobin, HPCV, MCV, MCH, MCHC, RDW and platelet between different group of treatments.

Total Red Blood Cells

Total RBC (x 1012/L)

Red Cell Distribution Width (RDW)

RDW (%)

4.5.1 Effects of the treatment on total white blood cells

Full Blood Count (FBC) analysis revealed that DMSO+carrageenan injection in the paw had cause a significant (P<0.05) elevation of white blood cells (WBC) (8.4 ± 1.0 %) when compared to control rats (DMSO+Saline) (3.7 +0.4 %).

However, there was no significant reduction of WBC in the rats treated with 50mg/mL extract + carrageenan (8.2 ± 0.8 %; p<0.05) when compared to DMSO+Carrageenan and the WBC counts was significantly higher when compared to control group. No significant different of WBC in the extract+saline and LNMMA+Carrageenan when compared to control group as shown in Figure 4.7.

Figure 4.7 The effect of treatment and carrageenan on total white blood count.

Carrageenan has caused a significant increase of the total white blood count when compared to DMSO + Saline treated rats. Data are presented as mean values of WBC count + SEM *P<0.05 (n=3).

DMSO+

Saline DMSO+Carr 50m

g/mL Extract+Saline 50mg/mL Extract+Carr

LNM MAA+Carr 0

5 10 15

Total WBC (x109 /L)

* *

63 4.5.2 Effects of the treatment on neutrophil

Statistical analysis on neutrophils count in blood showed no significant difference among groups at 24 hours post injection. However, result showed elevation in percentage of neutrophils in blood of carrageenan-induced rats when compared to control group. neutrophils count seems to be higher in DMSO + carrageenan (48 ± 15.1 %), 50 mg/mL extract + carrageenan (43 ± 13.8 %) and LNMMA + carrageenan (41 ± 6.7 %) treated rats compared to DMSO + saline (12.3% ± 2.2 %) as shown in Figure 4.8.

Figure 4.8 The effect of treatment and carrageenan on neutrophils. There is no significant difference among groups. However carrageenan-induced rats show elevation in percentage of neutrophils in blood when compared to DMSO + Saline treated rats.

4.5.3 Effects of the treatment on monocyte

Full Blood Count (FBC) analysis revealed that DMSO+carrageenan injection in the paw had cause a significant (P<0.0001) elevation of monocytes (10.0 ± 0.6 %) when compared to control rats (DMSO+Saline) (2.3 +0.3 %). Interestingly, analysis on the monocytes count revealed that there was significant (p<0.01) reduction of

DMSO+Saline

monocytes counts between the treatment, Frutus viticis extract + carrageenan (4.7 ± 0.7 %) and carrageenan group, DMSO + carrageenan (10.0 ± 0.6 %) as shown in Figure 4.9. In addition, Fructus viticis extract did not cause elevation of monocytes counts in FBC analysis as there was no significant alteration of monocytes in the Extract+saline (2.67 ± 0.89) when compared to DMSO+Saline (2.33 ± 0.33) . Furthermore, LNMMA + carrageenan treated rats showed a significant (p<0.0001) reduction of monocytes count (2.3 ± 0.8 %) when compared to carrageenan group.

Figure 4.9 Effect of treatments on the infiltration of monocytes at 24 hours post carrageenan or saline injection. DMSO + carrageenan treated rats thus results in significant increases of monocytes count when compared to other group. **P<0.01 &

****P<0.0001 (n=3).

DMSO+Saline

DMSO+Carr

50mg/mL Extract+Saline

50mg/mL Extract+Carr LNM

MA+

Carr 0

5 10 15

Cell count (%) ********

******

4.5.4 Effects of the treatment on lymphocyte, eosinophils and basophils

As shown in Figure 4.10, there was no significant difference in the infiltration of lymphocytes and eosinophils at 24 hours post carrageenan or saline injection despite of different in treatments. Moreover, there was no eosinophils infiltration in DMSO + carrageenan and LNMMA + carrageenan treated rats while eosinophils percentages in other group were ranged between 1-3 % (1.6 ± 0.3 %). On the other hand, average lymphocytes counts in all animals were between 44-87 % (69.8 ± 3.2

%). From the FBC analyses, no basophils were detected from the whole blood collected at 24 hours post saline or carrageenan injection.

Figure 4.10 Effect of treatments on the infiltration of lymphocytes (A) and eosinophils (B) from whole blood at 24 hours post carrageenan or saline injection.

No significant effect of treatments on the lymphocytes and eosinophils count in the whole blood.

4.6 DPPH Antioxidant Activity of Fructus viticis methanolic extract

The antioxidant activity of the Fructus viticis methanolic extract was measured by the ability to scavenge DPPH free radicals and was compared with the standard BHT. As expected the BHT showed excellent radical scavenging activities with maximum inhibition (81.40%) while maximum inhibition for the extract was

DMSO+Saline

(78.82%) at 1 mg/mL. IC50 for BHT and extract was 0.145 mg/mL and 0.365 mg/mL respectively.

Table 4.1 DPPH radical scavenging activity of Fructus viticis methanolic extracts with concentrations ranging from (0-1 mg/mL). BHT was used as a positive control.

Concentrations

(mg/mL) Mean value

± S.D Extract IC50

values (mg/mL)

(Mean value BHT

± S.D)

BHT IC50

values (mg/mL)

0 0

0.365

0.145

0.0156 9.26 ± 1.65 8.524 ± 0.00

0.0312 11.15 ± 1.17 16.62 ± 0.00

0.0625 16.06 ± 1.37 32.14 ± 0.00

0.125 22.91 ± 1.04 46.76 ± 0.00

0.25 35.23 ± 0.19 62.08 ± 0.00

0.5 60.95 ± 4.90 76.51 ± 0.00

1 78.82 ± 7.43 81.40 ± 0.00

Figure 4.11 Comparison of antioxidant activity of Fructus viticis methanolic crude extracts at different concentration. The antioxidant assay was done by using DPPH radical scavenging assay. Determination of 50% inhibition concentration (IC50) for BHT is 0.145 mg/mL and extract is 0.365 mg/mL.

68 4.7 Expected Results

4.7.1 Effects of the Treatment on Nitric Oxide (NO) Concentration in Paw Tissues Collected at 24 Hours Post Saline or Carrageenan Injection

NO is one of the important mediator in acute and chronic inflammation is generated via the oxidation of the terminal guanidino nitrogen atom of L-arginine by the enzyme, nitric oxide synthase (NOS). In our study, we expected that carrageenan injection cause elevation of nitric oxide production in the hind paw. Many reports have showed that injection with 1-3% of carrageenan has elevated the NO production in hind paws. Study by Mizokami et al., (2016) has shown that intraplantar injection of carrageenan on Male Swiss mice was able to induce nitric oxide (NO) production in the peritoneal cavity (Figure 4.12). Study by Boschi et al., (2008) showed that carrageenan increase the concentration of nitric oxide (NO) in the pleural cavity when compared to control group (Cg: 86.02 3.86 nmol, P ¼ 0.001) vs saline group (49.78 5.63 nmol)) (Figure 4.13).

Figure 4.12 Nitrite production in peritoneal exudates was determined 3 hours after carrageenan injection (Mizokami et al., 2016)

Figure 4.13 NO concentration in carrageenan and control group. Results are expressed as means SEM of eight animals. *P<0.05 (Boschi et al., 2008).

Study by Salvemini,et al., 1996 has shown that intraplantar injection of carrageenan in male Sprague-Dawley rats increased in paw volume with an elevated production of NO2-/N03- in the paw exudates (Figure 4.14). This increase in N02-/NO3- was observed within 30 min (from 0.5 + 0.05 nmol/paw to 16.2 +4 nmol/paw, n = 6), remained constant for the subsequent 3 h and then increased further at 6 and 10 h following carrageenan administration (Figure 4.14 a and b). In addition, based on this study, L-NMMA (300 mg/kg, n = 5) inhibited the N02-/NO3- production in paw exudate at both 3 and 10 h after carrageenan administration (Figure 4.14 a and b).

Therefore, we expect LNMMA will inhibit the production of NO 24 hours after injection with carrageenan. In addition, our treatment (50 mg/mL extracts + carrageenan) should inhibit/reduce the NO production at 24 hours post carrageenan injection since the treatment was found to delay the development of oedema.

Figure 4.14 Effects of carrageenan on NO2-/NO3- production at 3 (a) and 10 (b) h after carrageenan administration. The non-selective NOS inhibitors (LNMMA) inhibited NO2-/NO3- production at 3 and l0h (a and b), Each point is the mean+s.e.mean for n = 6. (Salvemini,et al., 1996).

4.7.2 Quantification of Inflammatory Cells in H&E Stained Paw Tissue

FBC analysis has revealed that carrageenan significantly increased monocytes count percentage when compared with DMSO + carrageenan treated rats. Carrageenan is

known to activate macrophages that will drive the local inflammatory reaction, and inflammatory cell infiltration. Therefore, histology analysis of paw tissue of carrageenan treated rats are expected to results in massive infiltrations of immune cells especially monocytes. We expect the DMSO + carrageenan group will results in more inflammatory cells infiltration compared to DMSO + saline group. Histological study by Buisseret et al., 2019 to assess immune cell infiltration of the paw was established at 6 and 24 h following carrageenan injection and revealed that carrageenan can induced a large infiltration of inflammatory cells in the paw, as seen in representative pictures (Figure 4.15 A and C). Consistently, a higher score was obtained in this group compared to the vehicle group for both time points. Study by Sadeghi et al., 2013 also suggests that carrageenan able to cause tissue changes, PMN infiltration, and swelling (Figure 4.16).

Figure 4.15 Mice were injected with 25 μL of carrageenan solution or saline vehicle into the plantar side of the right hindpaw. Mice were sacrificed at 6 h (A and B) or 24 h (C and D) after carrageenan injection. Representative pictures of hematoxylineosin stained sections, scale bar at 200 μm. (B and D) Histological scoring was performed at 6 (B) and 24 (D) hours after carrageenan administration. Values are mean ± s.e.m. (n = 8 per group). *P < 0.05, **P < 0.01, ***P < 0.001, compared to vehicle-carrageenan group, using one way ANOVA and Dunnett’s post-hoc test (Buisseret et al., 2019).

Figure 4.16 Histopathological evaluation of rat paws 4 h after subplantar injection of carrageenan. (A) Appearance of epidermis and dermis in normal rats without any lesion. (B) Subplantar injection of carrageenan induced edema, and migration of leukocytes mainly neutrophils (Sadeghi et al., 2013).

Study by Shin et al (2009) showed that carrageenan was able to increase the infiltration of immune cells including neutrophils, monocytes, and lymphocytes.

Increase in neutrophils, monocytes, and lymphocytes are more prominent although eosinophils and basophils were slightly increasing following carrageenan injection (Table 4.2).

Table 4.2 Immune cells infiltration after carrageenan injection (Shin et al 2009).

Treatment Vehicle Carrageenan alone

WBC 0.92 ± 0.29 9.44±3.31*

Neutrophils 0.16 ± 0.06 0.94±0.31*

Eosinophils 0.03 ± 0.02 0.06±0.04

Basophils 0.05 ± 0.04 0.09±0.33

Monocytes 0.07 ± 0.03 0.42±0.15*

Lymphocytes 0.64 ± 0.19 7.82 ± 2.89*

*: Significantly different from vehicle control (P<0.05)

74 CHAPTER 5

DISCUSSION

In this study, investigation of the effects of Fructus viticis methanolic crude extract on acute inflammatory pain evaluated by carrageenan induced paw oedema was done by assessing four parameters including paw thickness, pain threshold, systolic blood pressure, and full blood count analysis. In addition, antioxidant activity of Fructus viticis methanolic extract was investigated using DPPH radical scavenging assay.

5.1 Fructus viticis effects on carrageenan-induced paw oedema model Carrageenan is a one of inflammatory agents that is commonly used for induction of acute inflammatory pain by intraplantar injection of animal model to develop paw oedema (Ou et al., 2019). Therefore, carrageenan- induced paw oedema model was used in this study as it is a well-defined, widely and frequently used working model of inflammation in the search for new anti-inflammatory drug (Kuedo et al., 2016).

Furthermore, paw oedema is a convenient method for assessing inflammatory responses to antigenic challenges and irritants (Kuedo et al., 2016; Kim et al., 2020;

Sarkhel, 2016).

The thickness of paw oedema is one of the parameter taken for assessing the development of inflammation. Acute paw oedema are caused by the increased vascular permeability and plasma extravasation which caused accumulation of fluid, leukocytes and mediators at the site of inflammation (Helen et al., 2018).

Inflammation induced by carrageenan is biphasic (Bao et al, 2018; Kim et al, 2018)

whereat the early phase (first 2 h after carrageenan injection) is attributed to the release of proinflammatory mediators, such as histamine and serotonin; the late phase (3–5 h after carrageenan injection) is mainly mediated by neutrophil infiltration into the inflammatory site and the production of large amounts of pro-inflammatory mediators such as kinins, prostaglandin, nitric oxide, cyclooxygenase, cytokines such as IL-1β, IL-6, IL-10 and TNF-α, and neutrophil derived free radicals (Moon et al., 2018; Ismail et al., 2016; Kim et al, 2020).

Previous studies have shown that intraplantar injection of carrageenan showed a noticeable difference in gross morphology such as increased redness, hotness, swelling, painful paw tissue oedema (Helen et al., 2018; Kim et al, 2020;

Abd-Allah et al., 2018). Similarly, in our study it was demonstrated that injection of 100 µL of 2% λ-carrageenan results in massive oedema (swelling) that characterized by the increase of paw thickness which significantly elevated within 30 minutes after carrageenan injection, reaching peak at 4 h to 8 h before starting to resolve at 24 hours post-carrageenan injection. Paralleled with the study by Ialenti et al., (2017);

Abd-Allah et al., (2018); Yuan et al., (2017) where paw oedema started to develop at 0.5 h, where injection of 100 µL of 1% λ-carrageenan of carrageenan to the rat hind paw caused an oedema peaking between 3 and 4 hours. The peak time of eodema development is slightly different from our study because of the different carrageenan concentration used where in our study we used 2% (w/v) of λ-carrageenan instead of 1% (w/v).

Moreover, gross observation of rat hind paw treated with Fructus viticis extract showed less cardinal sign of inflammation including redness, heat, swelling and pain

compared to control (DMSO + Carrageenan). Our study has revealed that animal treated with Fructus viticis extract showed significant delay in the development of oedema at 4 h to 6 h post carrageenan injection when compared to control group (DMSO + Carrageenan). The ability of the extract to resolve the inflammation might be due to the bioactive compound in the crude extract that inhibit the known classical inflammatory pathway such as the Toll like receptor-4 (TLR4) mediated Nuclear factor kappa B (NF-κB) activation that control the regulation of proinflamamtory

In document EVALUATION OF Fructus Viticis METHANOLIC CRUDE EXTRACT AS ANTIOXIDANT AND ANTI-INFLAMMATORY IN CARRAGEENAN (halaman 72-0)